Type 1 Diabetes

Definition

Diabetes is a higher level of glucose in the blood than is normal. Glucose travels through your body in the blood. A hormone called insulin then helps glucose move from your blood to your cells. Once glucose is in your cells it can be used for energy. A problem making or using insulin means glucose can not move into your cells. Instead the glucose will build up in your blood.

In type 1 diabetes, the body does not make insulin. This will lead to the build up of glucose in the blood, also called hyperglycemia. At the same time, your cells are not getting glucose they need to function well. Over a long period of time high blood glucose levels can also damage vital organs. The blood vessels, heart, kidneys, eyes, and nerves are most commonly affected organs.

Type 1 diabetes is often found during childhood and young adulthood.

Causes

Our immune system keeps us well by fighting off and destroying viruses and bacteria. Unfortunately, sometimes the immune system attacks healthy tissue. Most type 1 diabetes develop because the immune system attacks and destroys the cells that make insulin. These cells are in the pancreas.

It is not yet clear why the immune system attacks these cells. It is believed that some people have genes that make them prone to getting diabetes. For these people, certain triggers in the environment may make the immune system attack the pancreas. The triggers are not known but may be certain viruses, foods, or chemicals.

Type 1 diabetes may also develop as a complication of other medical conditions. It may develop in:

Symptoms

Type 1 diabetes may cause:

Weight loss

Increased urination

Extreme thirst

Hunger

Fatigue, weakness

Blurry vision

Irritability

Headaches

Without insulin your body will need to find new forms of energy. This will cause an imbalance in the body called
ketoacidosis.
It is a severe state that can lead to coma or death. Ketoacidosis may cause:

You may also need other blood tests to confirm diabetes is type 1 and not type 2. These may include:

Insulin level or C-peptide tests—to see how much insulin is being made by the pancreas

Tests that look for antibodies that are working against your pancreas

Treatment

Diabetes treatment goal is to maintain blood sugar at levels as close to normal as possible. Regular medical care is important for preventing or delaying complications.

While diabetes makes blood glucose levels too high, treatment can make blood glucose levels go too low. This is called hypoglycemia. It can cause confusion, shakiness, anxiety, heart palpitations and more. If the levels fall too low it can cause seizures and loss of consciousness. You and your doctor will plan and adjust your medication and diet to keep the risk of hypoglycemia low.

Insulin

Insulin injections replace the insulin you are missing. The amount given is based on your individual need and a blood glucose test you take before and after meals and at bedtime. You will need to have insulin shots two or more times daily.

You may also have an insulin pump that automatically gives you small amounts of insulin through the day.

Pramlintide

Amylin is made in the pancreas along with insulin. In people with type 1 diabetes, this hormone, like insulin, is missing. The missing amylin may be responsible for the blood glucose rise after a meal in
people with
diabetes. The drug pramlintide may be used when insulin therapy is not enough to control blood sugar.

Glucagon

Glucagon can be injected to quickly increase blood glucose level. People with type 1 diabetes should always have an emergency supply available in case of hypoglycemia.

If you are diagnosed with type 1 diabetes consider getting a medical alert ID. It will let others know you have diabetes in case you are unable to communicate.

Diet

If you have type 1 diabetes, you should meet often with a registered dietitian. Generally speaking, it is best to:

Follow a well-balanced meal plan with a variety of food groups.

Eat at regular times each day. Include a bedtime snack in your meal plans. Do not skip meals

Avoid highly refined carbohydrates. This includes sugar or high fructose products like soda.

Exercise

Exercise is encouraged as long as blood glucose levels are under control. Follow your doctor's advice on activity levels and changes you may need to make.

You may need to adjust your insulin dose or diet if you are having low glucose levels after exercise.

Blood Sugar Testing

Regular blood glucose checks throughout the day will help you manage your diabetes. Testing is often done with a blood glucose monitor. You can also ask your doctor about continuous monitoring systems that you wear all day.

Keep a record of the results to show your doctor. Your treatment plan may change based on your test results. The
HbA1c blood test is also used by your doctor to assess your overall glucose control.

Pancreatic Islet Cell Transplant

This is a procedure that is still being investigated. It involves transplanting islet cells from a donor to a person with type 1 diabetes. After the transplant, these new cells are able to produce insulin. In some cases, people who receive these transplants may no longer need insulin injections.

Closed-Loop Artificial Pancreas

This device is still being studied and developed. It is a continuous glucose monitoring system (CGMS). This system can automatically checks glucose levels through the day. Insulin is then delivered as needed through the day and night. The monitoring system will allow you to keep your blood sugar levels within the normal range without daily testing or injections.

Pancreatic Transplant

Acute diabetic complications or emergencies that can not be prevented by insulin

Severe problems due to injecting large amounts of insulin

Severe and frequent complications related to diabetes such as severe recurrent hypoglycemia

Counseling

Depression can undermine your recovery and put you at risk for other complications. Feelings of sadness, hopelessness, and loss of interest in your favorite activities that stay with you for at least 2 weeks should prompt you to call your doctor. Depression is treatable. Your doctor may refer you to counseling to help you better manage your diabetes.

Prevention

There are no current guidelines to prevent type 1 diabetes.

Some research is looking at the effectiveness of suppressing the immune system. This may be helpful in people who are at high risk of developing type 1 diabetes.

Revision Information

This content is reviewed regularly and is updated when new and relevant evidence is made available. This information is neither intended nor implied to be a substitute for professional medical advice. Always seek the advice of your physician or other qualified health provider prior to starting any new treatment or with questions regarding a medical condition.

American Association of Clinical Endocrinologists. American College of Endocrinology. Medical guidelines for the clinical practice for the management of diabetes mellitus.
Endocrine Pract. 2007;13(suppl 1)3-68.

American Association of Clinical Endocrinologists. American College of Endocrinology. Medical guidelines for the management of diabetes mellitus: the AACE system of intensive diabetes self-management. 2002 update.
Endocrine Pract. 2002;8(suppl 1)S40-82.

The DCCT/Epidemiology of Diabetes Interventions and Complications Research Group. Retinopathy and nephropathy in patients with type 2 diabetes four years after a trial of intensive therapy.
N Engl J Med. 2000;342:381-389.